An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi‐experimental study at a veterans affairs medical center

Saint, Sanjay; Fowler, Karen E.; Krein, Sarah L.; Flanders, Scott A.; Bodnar, Timothy W.; Young, Eric W.; Moseley, Richard H.

doi:10.1002/jhm.2105

Cited by 21 publications

(30 citation statements)

References 32 publications

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“…Furthermore, ''pre-rounding'' to prepare for rounds must be restricted [14]. Functional work rounds may provide excellent patient care coupled with focused education [15] all while reducing the number of required room entries. These measures are intended to protect surgical team members and to preserve supplies of scarce PPE.…”

Section: Patient Environmentmentioning

confidence: 99%

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

Heffernan

Evans

Huston

et al. 2020

Surgical Infections

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Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.

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Section: Patient Environmentmentioning

confidence: 99%

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

Heffernan

Evans

Huston

et al. 2020

Surgical Infections

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“…Likewise, a non-bundled intervention by Gausvik et al 56 resulted in an improvement in 30-day readmission for patients discharged to a skilled nursing facility (SNF) (11.68% vs 14.7%, p<0.05), decreased LOS for patients discharged to an SNF (5.24 days vs 7.26 days, p<0.001) and decreased LOS for patients discharged to home (3.73 days vs 4.21 days, p=0.001). However, bundled interventions involving BR by Dunn et al 39 and Saint et al 48 did not result in a statistically significant difference in LOS when compared with control units.…”

Section: Resultsmentioning

confidence: 84%

Implementing bedside rounds to improve patient-centred outcomes: a systematic review

et al. 2018

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“…Attending physician 2 (1-3) 13 (11)(12)(13)(14)(15) . prove education, 1,14,26,29,30,37,38 although others do not.…”

Section: Discussionmentioning

confidence: 99%

“…14 On some services, attending physicians commonly join both new patient rounds and work rounds on previously admitted patients, which used to be the domain of residents alone. 15,16 However, it is unclear what effect this increased direct clinical supervision on work rounds has on patient safety and to what extent it affects progressive trainee independence. 7,12 In response to these concerns, we conducted a randomized, crossover clinical trial of 2 levels of supervision on an inpatient general medical teaching service to evaluate patient safety and educational outcomes.…”

mentioning

confidence: 99%

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education

et al. 2018

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IMPORTANCE While the relationship between resident work hours and patient safety has been extensively studied, little research has evaluated the role of attending physician supervision on patient safety. OBJECTIVE To determine the effect of increased attending physician supervision on an inpatient resident general medical service on patient safety and educational outcomes. DESIGN, SETTING, AND PARTICIPANTS This 9-month randomized clinical trial performed on an inpatient general medical service of a large academic medical center used a crossover design. Participants were clinical teaching attending physicians and residents in an internal medicine residency program. INTERVENTIONS Twenty-two faculty provided either (1) increased direct supervision in which attending physicians joined work rounds on previously admitted patients or (2) standard supervision in which attending physicians were available but did not join work rounds. Each faculty member participated in both arms in random order. MAIN OUTCOMES AND MEASURES The primary safety outcome was rate of medical errors. Resident education was evaluated via a time-motion study to assess resident participation on rounds and via surveys to measure resident and attending physician educational ratings. RESULTS Of the 22 attending physicians, 8 (36%) were women, with 15 (68%) having more than 5 years of experience. A total of 1259 patients (5772 patient-days) were included in the analysis. The medical error rate was not significantly different between standard vs increased supervision (107.6; 95% CI, 85.8-133.7 vs 91.1; 95% CI, 76.9-104.0 per 1000 patient-days; P = .21). Time-motion analysis of 161 work rounds found no difference in mean length of time spent discussing established patients in the 2 models (202; 95% CI, 192-212 vs 202; 95% CI, 189-215 minutes; P = .99). Interns spoke less when an attending physician joined rounds (64; 95% CI, 60-68 vs 55; 95% CI, 49-60 minutes; P = .008). In surveys, interns reported feeling less efficient (41 [55%] vs 68 [73%]; P = .02) and less autonomous (53 [72%] vs 86 [91%]; P = .001) with an attending physician present and residents felt less autonomous (11 [58%] vs 30 [97%]; P < .001). Conversely, attending physicians rated the quality of care higher when they participated on work rounds (20 [100%] vs 16 [80%]; P = .04). CONCLUSIONS AND RELEVANCE Increased direct attending physician supervision did not significantly reduce the medical error rate. In designing morning work rounds, residency programs should reconsider their balance of patient safety, learning needs, and resident autonomy.

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An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi‐experimental study at a veterans affairs medical center

Cited by 21 publications

References 32 publications

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

Implementing bedside rounds to improve patient-centred outcomes: a systematic review

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education

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